Fall in healthcare use after one year
The data compares healthcare use and costs six months before a referral and six months after; and one year before a social prescribing referral and one year after. It focuses on 168,699 patients who were referred to social prescribing between July 2019 and April 2022.
The raw data shows an overall rise in healthcare use in the six months after a referral to social prescribing, compared to six months before; but an overall fall in healthcare use and costs one year after a referral compared to one year before:
“People referred to social prescribing had, on average, 9·9 contacts with primary and secondary care in the 6 months leading up to their referral and slightly more (10.3) contacts in the 6 months following referral.
“They had fewer (17·8) contacts in the year following referral compared to the average of 19·1 contacts in the year leading up to referral. In contrast, non-referred patients had fewer contacts in the 6 months after their matched patients’ referral dates than they did in the 6 months before (7·9 versus 9·6 contacts) and more contacts in the year after compared to the year before (17·0 versus 15·4 contacts).”
The costs for patients referred to social prescribing reduced by £115 on average comparing 12 months after referral with 12 months before, at 2022 prices, while the costs for those not referred increased*.
It is worth noting that the data tracks what happens after the initial referral, rather than after a patient receives support from a link worker. The initial rise in healthcare use may include GPs referring patients to other services alongside a referral to a link worker, or patients accessing other services while waiting for their first appointment with a link worker. Typically, link workers see patients for 4-12 sessions, so the full impact of social prescribing is likely to take several months to emerge.
The short-term rise in healthcare use may also reflect an increase in health-seeking behaviour among patients – for example, with patients with long-term conditions taking tests that they had previously avoided.
The longer-term fall in healthcare use and costs after one year, compared to one year before, is more likely to reflect the impact of social prescribing on healthcare use and costs.
Comparing with matched case-control cohort
As part of the study, the authors compared patients referred to social prescribing with those not referred, matching patients through a range of metrics (including conditions, previous healthcare usage and demographics).
This model suggests higher healthcare use among patients referred to social prescribing than among those not referred after six months, but lower numbers of general practitioner appointments after one year.
While the authors matched for various factors in patients' lives, they state that: ‘As social prescribing aims to address complex social needs, there are likely to be additional unmeasured differences between these patient groups.’
Patients referred to social prescribing are likely to be referred for a reason - for example, because they are facing urgent problems related to housing, debt, financial issues, bereavement, a relationship breakdown or an escalation in loneliness and isolation. These problems may affect the patient's health and wellbeing and mean that, understandably, their likely healthcare use is higher in the short term, compared to those who are not facing equivalent challenges.
However, as the authors acknowledge, it is positive that the healthcare usage then lower for the group referred to social prescribing after 12 months, suggesting that social prescribing may be effective in “enabling patients to address non-medical needs, stabilise their use of healthcare services, and seek support from appropriate community resources rather than continued clinical care."
One limitation of the study is that the data tracks "referrals" rather than interventions. As the authors state, the record of a referral “does not indicate take-up, fidelity, or a patient’s readiness to engage. This is not recorded in CPRD; this means our results can only be interpreted as referrals to social prescribing, not engagement.” From this data alone, it is impossible to unpick what level of social prescribing support, if any, people who were referred actually received.
How this builds on previous studies
Previous studies have demonstrated the positive impact that social prescribing has on wellbeing outcomes, with one recent study suggesting that it has a social value of £9 for every £1 invested, based on an analysis of Wellbeing-Adjusted Life Years.
Several other studies, including by NASP, have associated social prescribing with a fall in healthcare use and costs - particularly for patients who frequently access health services.
The new paper is a valuable, large-scale attempt to investigate the actual impact of social prescribing, matching patients referred and not referred by demographics.
Some of the findings are at odds with previous findings, possibly due to the methodology of comparing differences between samples rather than tracking healthcare usage for individuals over time. The paper demonstrates the need for more research, to further unpick the difference that social prescribing makes in practice to people with similar demographics and which can examine individualised effects that may affect their health and wellbeing.
*based on data from Table 2 of the report
